JP2023091678A - Support device - Google Patents

Abstract

To provide a support device and a support method which can reduce support of a physical therapist in rehabilitation of a patient whose deviation of the Subjective Visual Vertical (SVV) is not normal.SOLUTION: A support device for supporting rehabilitation of a patient having vertical visual impairment comprises: a head mount unit which can be mounted on the head of the patient; an imaging unit which is attached to the head mount unit and can capture an image of an outer scenery corresponding to an outer scenery entering the visual field of the patient; an image generation unit which generates a correction image obtained by tilting the image captured by the imaging unit to a prescribed tilt angle according to the deviation of the Subjective Visual Vertical (SVV) of the patient; and a display unit which is attached to the head mount unit, and displays the correction image for the patient so as to correspond to capturing of the image of the outer scenery by the imaging unit.SELECTED DRAWING: Figure 1

Description

TECHNICAL FIELD The present invention relates to an assisting device and an assisting method for assisting rehabilitation.

Stroke can lead to pathological changes in visual vertical sensation. This can cause the patient to feel that they are standing straight, but they are actually leaning over. As a result, patients may experience falls, dizziness, loss of balance, and gait disturbances. This disturbance of vertical sensation is considered to be caused by disturbance of "axis" sensation. The "axis" is processed at a higher order in the brainstem, cerebellum, cerebral cortex, etc. through input from the semicircular canals, otoliths, vision, and the like. Lateropulsion is known as a symptom caused by disturbance of this "axis" sensation. Lateropulsion is an involuntary leaning to one side or tendency to fall, not due to motor paralysis or muscle weakness.

By the way, a subjective visual vertical (SVV) test is clinically used as a test for judging vertical sensation (Non-Patent Document 1). In addition, a method has been proposed for subacute stroke patients with lateropulsion that uses a body tilt device and a visual feedback monitor to perform rehabilitation interventions to correct the deviation of the body, and to make the body memorize the balance of the correct posture. (Non-Patent Document 2).

Dieterich M, Brandt T. Ocular torsion and tilt of subjective visual vertical are sensitive brainstem signs. Ann Neurol1993;33:292－299. An CM, Ko MH et al. Effect of postural training using a whole-body tilt apparatus in subacutestroke patients with lateropulsion: A single-blinded randomized controlled troal. Ann Phys Rehabil Med. Epub 2020 Oct 14.

However, the above methods also require the constant assistance of medical personnel. The present invention has been made to solve the above problems, and aims to provide a support device and a support method that can reduce the support of medical staff in the rehabilitation of patients with SVV deviation. aim.

The present invention is a support device for assisting rehabilitation, comprising a head-mounted unit that can be worn on the head of a patient, and an image of an external scene that is attached to the head-mounted unit and that is within the field of view of the patient and the corresponding external scene. an image generating unit that generates a corrected image by tilting the image captured by the imaging unit at a predetermined tilt angle according to the deviation of the patient's subjective vertical position (SVV); A display unit attached to the head-mounted unit, the display unit displaying the correction image to the patient so as to correspond to the imaging of the image of the outside scene by the imaging unit.

The support device can make the rehabilitation rehabilitation of a patient with lateropulsion.

The support device may be configured to change the tilt angle during rehabilitation.

The support device can be configured so that the corrected image can be output to an external display device.

The support device may further include an SVV measurement unit that measures the SVV.

In the assisting apparatus, the image generation unit may be configured to synthesize an image for prompting the patient to perform correction with the correction image.

In the assisting apparatus, the image generator may be configured to synthesize an image of a moving object that can be tracked by the patient with the corrected image.

The present invention is a support method for assisting rehabilitation, comprising the steps of capturing an image of an external scene corresponding to an external scene in the field of view of the patient; ) generating a corrected image tilted at a predetermined tilt angle in accordance with the deviation of ), and displaying the corrected image to the patient so as to correspond to shooting of the image of the outside scene ing.

In the support method, the rehabilitation may be rehabilitation of a patient with lateropulsion.

ADVANTAGE OF THE INVENTION According to this invention, a medical staff's support can be reduced in the rehabilitation for the patient whose deviation of SVV is not normal.

1 is a schematic configuration diagram showing an embodiment of a support device according to the present invention; FIG. 3 is a block diagram of a head mounted unit and a controller; FIG. 1 is a front view of a patient biased by SVV; FIG. FIG. 11 illustrates generation of a corrected image; It is a flow chart of rehabilitation using a support device. It is a figure explaining rehabilitation of a patient. FIG. 10 is a diagram showing another example of a corrected image;

A stroke may be followed by a symptom called lateropulsion, which indicates an involuntary leaning of the body to one side and a tendency to fall, not due to motor paralysis or muscle weakness. Although lateropulsion has been commonly seen in lateral medullary infarction, it has recently been found to occur in relatively extensive supratentorial lesions. However, supratentorial lesions are often accompanied by other neurological symptoms such as motor paralysis, ataxia, and higher brain dysfunction, and it is possible that lateropulsion is overlooked. Diagnosis of lateropulsion is characterized by deviation of subjective vertical visual field (SVV) in addition to symptoms, so SVV measurement is useful.

In lateropulsion caused by acute vestibular neuritis or lateral medulla oblongata lesions, it is known that the eyeballs turn in the same direction (laterpulsion side) when the eyes are closed at rest, and these can be confirmed by head CT and MRI. . In patients with lateropulsion, the direction of eyeball deviation differs depending on the lesion site, but the eyeballs deviate when the eyes are closed at rest, according to head CT or MRI. These findings suggest that there is a close visual-vestibular interaction between vision and vestibular sensation in patients with lateropulsion. Therefore, the present inventors thought that visual intervention might be effective for lateropulsion, and arrived at the present invention.

Incidentally, lateropulsion is a symptom that indicates an involuntary inclination of the body to one side and a tendency to fall, not due to motor paralysis or muscle weakness. Patients with lateropulsion syndrome tend to lean to the paralyzed side in all postures, show a tendency to fall, and tend to resist passive modification of posture. Such phenomena are conventionally expressed as pusher syndrome (behavior), pushing syndrome (behavior), ipsilateral pushing, listing phenomenon, thalamic astasia, ease of falling, lateropulsion, postural disorientation, lateral thrust phenomenon, and thalamic loss. It is called tatsusho, etc., and no unified view has been presented. On the other hand, there is also a document showing the opinion that lateropulsion is appropriate (Annals of Physical and Rehabilitation Medicine 64 (2021) 101595). Therefore, in this specification, it is described as lateropulsion in principle.

An embodiment of a support device for supporting rehabilitation according to the present invention will be described below with reference to the drawings. In addition, in one embodiment described below, it is assumed that the rehabilitation of a patient having symptoms of lateropulsion is supported.

<1. Hardware Configuration of Support Device>
FIG. 1 is a schematic configuration diagram of a support device. This support device comprises a head-mounted unit 1 to be attached to a patient with vertical visual impairment, a controller 2 for controlling and operating the head-mounted unit 1, and a cable 3 electrically connecting them. there is These will be described in detail below.

<1-1. Head mount unit>
As shown in FIG. 1, the head mounted unit 1 has a spectacles-shaped frame 11. When the patient wears the head mounted unit 1, the frame 11 has a front view of the patient's right and left eyes. A right display portion 12 and a left display portion 13 are arranged in the respective positions. Also, in the frame 11, a camera 14 is provided between the two display portions 12 and 13, that is, in a portion corresponding to the bridge of spectacles. Each of the display units 12 and 13 is provided with a display such as a liquid crystal display (hereafter referred to as "LCD"), so that the patient's eyes perceive an image displayed on the LCD. The camera 14 can be composed of a known monocular camera or a stereo camera, and is adapted to photograph the outside scene as a moving image.

The term "outside scenery" as used herein means the scenery of the real space reflected by the camera 14 of the head-mounted unit 1 or the scenery of the real space perceived by the patient's naked eyes, regardless of whether the patient is outdoors or indoors. The external scene perceived by the patient's naked eyes corresponds to the external scene captured by the camera 14 when the patient wears the head mount unit 1 .

Images displayed on the display units 12 and 13 are generated by the controller 2 based on moving images captured by the camera 14, as will be described later.

In addition, the frame 11 is provided with a 9-axis sensor 16 and a biosensor 17 . As the 9-axis sensor 16, for example, a motion sensor that detects acceleration (three axes), angular velocity (three axes), and geomagnetism (three axes) can be employed. The biosensor 17 acquires biometric information such as heart rate, body temperature, and oxygen concentration of the patient wearing the head-mounted unit 1 .

<1-2. Controller>
FIG. 2 is a block diagram of the head mount unit and controller. As shown in FIGS. 1 and 2, the controller 2 includes a rectangular parallelepiped housing 21, which houses a control unit 22, a storage unit 23, an external interface 24, and a battery 25. It is A display 211 and operation buttons 212 are arranged on the surface of the housing 21 .

The control unit 22 is mainly composed of a CPU, RAM, ROM, and the like. The storage unit 23 can be configured with a known storage device such as an HDD or an SSD, and stores a program 231 for driving this support device, patient data 232 regarding the patient's SVV, etc., data 233 regarding the patient's rehabilitation results, and the like. various data are stored. The patient data 232 includes, for example, the deviation (angle) of the SVV.

Then, when the control unit 22 executes the program 231 stored in the storage unit 23, the control unit 22 virtually performs the image acquisition unit 221, the image generation unit 222, the image output unit 223, the display control unit 224, the attachment detection It functions as a unit 225 and a data acquisition unit 226 . These functional configurations (software configurations) will be described later.

The external interface 24 is for connecting with an external device, for example, for externally storing data in the storage unit 23 . Specifically, a USB interface, an interface for memory cards, or the like can be used.

The battery 25 supplies power to drive the head mount unit 1 via the controller 2 and cable 15 . The battery 25 may be, for example, a known lithium-ion battery, but may be either a primary battery or a secondary battery.

The operation buttons 212 of the housing 21 are a power button for turning ON/OFF the power of the controller 2 and the head mounted unit 1, angle adjustment for SVV correction, and image and brightness adjustment of the display units 12 and 13. These are various operation buttons for performing The display 211 also displays, for example, the content of rehabilitation.

<2. Software Configuration of Support Device>
As described above, when the program is executed in the CPU, the controller 2 functions as an image acquisition unit 221, an image generation unit 222, an image output unit 223, a display control unit 224, an attachment detection unit 225, and a data acquisition unit 226. do. These functional configurations will be described below.

The image acquisition unit 221 acquires an image of the outside scenery captured by the camera 14 as a moving image, and stores the moving image in the RAM of the control unit 21 . The image generator 222 can display the stored moving images on the display units 12 and 13 . When the image generation unit 222 does not perform image processing on the moving image, the patient wearing the head-mounted unit 1 can view the external scene through the display units 12 and 13 in substantially the same manner as when viewing the external scene with his own naked eyes. You can see the outside scenery. On the other hand, when performing rehabilitation, the image generator 222 performs image processing for each frame that constitutes a moving image. At this time, the image generation unit 222 extracts the patient's SVV deviation from the patient data 232 stored in the storage unit 23, and performs image processing on each frame image so as to correct the deviation. For example, assuming that the patient is tilted to the right due to SVV as shown in FIG. 3(a), the external scene appears to the patient to be tilted to the left as shown in FIG. 3(b). Therefore, the control unit 21 tilts each frame image from the state shown in FIG. 3B to the side opposite to the eccentricity as shown in FIG. For convenience of explanation, FIG. 3B shows the inclination of the external scene relative to the patient, with the upper body of the patient straightened. This point also applies to FIGS. 4 and 6(a).

The image output unit 223 has a function of connecting the frame images in time series and outputting them to the display units 12 and 13 of the head mounted unit 1 as corrected images. As a result, the patient can see a corrected image in which the image of the outside scene captured by the camera 14 is tilted based on the SVV paradox. Since the camera 14 captures the external scene in the direction in which the patient's face is facing, the external scene that is generally within the field of view of the patient is captured. Because the image of the outside scene is tilted in real time and appears on the displays 12, 13, a patient with SVV bias will see a straight image to the patient, even though the image is actually tilted.

Further, the image output unit 223 has a function of outputting the correction image to, for example, a display of an external device via the external interface 24 as well as the display units 12 and 13 by setting.

The display control unit 224 has a function of adjusting the brightness and color of the LCDs of the display units 12 and 13 according to the operation of the operation button 212 of the controller 2 .

The wearing detection unit 225 has a function of detecting whether or not the patient is wearing the head mount unit 1 correctly. . If the detected angle indicates that the head mount unit 1 is not properly attached, a warning is issued by means of sound, light, or characters displayed on the display 211 .

The data acquisition unit 226 has a function of storing various data in the storage unit 23 . For example, the deviation of the patient's SVV, the time the patient used this support device, the patient's biological data acquired by the biosensor 17, the course of rehabilitation, for example, the transition of the SVV inclination angle, etc., are recorded in the patient data 232 or rehabilitation It is stored in the storage unit 23 as data 233 .

<3. Rehabilitation with support equipment>
Next, patient rehabilitation by the support device configured as described above will be described with reference to the flow chart of FIG. First, the patient's SVV deflection is measured by a known SVV measuring device (step S11), and the deflection angle is input to the controller 2 using the operation button 212 (step S12). Thereby, the data acquisition unit 226 stores the angle of deviation in the patient data 232 . Alternatively, the data acquisition unit 226 may read the patient data 232 stored in the USB memory and store it in the storage unit 22 .

Next, the head mount unit 1 is attached to the patient's head (step S13), and the power of the controller is turned on (step S14). As a result, the 9-axis sensor 16 of the head mount unit 1 is driven, and when the head mount unit 1 is mounted on the patient's head at the correct angle (YES in step S15), the display units 12 and 13 are corrected. An image is displayed (step S16). On the other hand, when the 9-axis sensor 16 determines that the head mount unit 1 is not mounted at the correct angle (NO in step S15), a warning is issued (step S17). This allows the patient or caregiver to reattach the head mount unit 1 at the correct angle.

As described above, the correction images displayed on the display units 12 and 13 are images captured by the camera 14 and subjected to image processing in real time. You can see the outside scenery straight ahead. Therefore, as shown in FIG. 6(b) from the state (FIG. 4(b)) of FIG. Rehabilitation is carried out so that the external scene of the corrected images displayed on the display units 12 and 13 can be seen straight (step S18). Patients can perform rehabilitation while walking instead of just standing still. Moreover, while performing rehabilitation, various biological data can be acquired by the biological sensor 17 and stored in the storage unit 23 . During rehabilitation, depending on the degree of deviation of SVV, medical personnel such as physical therapists and caregivers may provide support.

In this way, it is thought that SVV paradoxism will be cured by repeating rehabilitation so that the patient can tilt the body so that the corrected image can be seen straight.

<4. Features>
As described above, according to the present embodiment, the patient can perform rehabilitation by tilting the body according to the correction images displayed on the display units 12 and 13. Therefore, it is possible for physical therapists and other medical professionals to perform rehabilitation. caregiver assistance can be reduced.

For example, it can be used during bedside rehabilitation after cerebral infarction has developed and treatment has been performed and after recovery of consciousness, and during bedside rehabilitation after the patient's condition has stabilized. Early intervention is therefore possible. In the above description, rehabilitation with the patient standing has been described, but it can also be used with the upper body raised in bed.

<5. Variation>
Although one embodiment of the present invention has been described above, the present invention is not limited to this, and various modifications are possible without departing from the gist of the present invention. Note that the following modified examples can be combined as appropriate.

(1) In the above embodiment, the angle of deviation of the SVV is input, and the image generation unit 222 tilts the outside scene at that angle. can do. For example, at the beginning of rehabilitation, the tilt angle may be reduced to gradually approach the measured SVV deviation. For example, the tilt angle may be fixed during a single rehabilitation session, or may be varied during a single rehabilitation session.

(2) The image generation unit 222 can optionally perform image processing for each frame on the moving image acquired by the image acquisition unit 221 according to the operator's operation, and tilt the outside scene image at an arbitrary angle. For example, the patient starts from looking at the outside scene image without image processing (for example, the state of FIG. 3(b)), and gradually tilts the outside scene image until it looks straight (for example, the state of FIG. 4). to interrupt the processing of the outside scene image. This allows the patient to be aware that his or her visual field is tilted.

(3) The images that are subjected to image processing and output to the display units 12 and 13 may include, for example, another person's face, one's own face reflected in a mirror, a book, or the like. Also, the images to be output to the display units 12 and 13 do not have to be the outside scenery captured by the camera 14 in real time. For example, it is also possible to output an outside scene photographed in the past to the display units 12 and 13 . In addition, it is also possible to generate in advance a moving image showing a virtual space instead of the scenery of the real space as the outside scenery, and display this on the display units 12 and 13 . In this case, the image generator 222 can generate a corrected image based on the moving image showing the virtual space.

(4) In the above-described embodiment, the camera 14 is attached to the center of the head-mounted unit 1, so that the outside scenery, which is the outside scenery in the direction the patient is facing, is photographed. Therefore, although it is not necessary to correct the correction images displayed on the display units 12 and 13 according to the tilt of the head mount unit 1, it is possible to generate correction images more accurately or depending on the type and position of the camera 14. For example, the inclination of the head mount unit 1 can be detected by the 9-axis sensor 16, and the inclination of the correction image can be corrected based on this.

(5) By using known AR (Augmented Reality) technology, etc., the patient can correct the correction image by himself up to the target angle. For example, as shown in FIG. 222, an image for prompting correction, such as an arrow, a character, or letters (instructions for rehabilitation, etc.), can be combined with the correction image. It is also possible to give a reward as a successful experience when the posture reaches the target.

(6) In the above embodiment, the head mount unit 1 and the controller 2 are separated, but the controller 2 can be attached to the head mount unit 1 to integrate them. Moreover, the form of the head mount unit 1 is not particularly limited, and it is sufficient that it can be worn at least on the patient's head and that the correction images displayed on the display units 12 and 13 can be perceived by the patient's eyes. . Moreover, in the above embodiment, the display units 12 and 13 are provided so as to correspond to each eye, but the display unit may be configured with one screen that is viewed with both eyes.

(7) In the above embodiment, the SVV measurement is performed by another measuring device, but the SVV measurement unit may be provided with a measurement function so that the SVV measurement is performed by this support device.

(8) In the above embodiment, when generating a corrected image, image processing is performed for each frame image that constitutes a moving image. , image processing that can generate a corrected image.

(9) In Europe and the United States, vestibular rehabilitation therapy (VT) is used as a standard treatment for patients with vestibular neuritis, Meniere's disease, and other vestibular diseases, and its effectiveness has been reported. there is As one of the contents of the training, for the purpose of vestibular adaptation, by quickly moving the head and eyeballs toward the target in front of the eyes, the shift of the image on the retina is generated and the eyeball movement is promoted. Adaptation Exercise is known. However, in lateropulsion patients with SVV deviation, training is in an environment in which the vertical axis is deviated, so it cannot be said to be effective. Therefore, VT training in an environment of true visual verticality with corrected images in the support device according to the present invention may promote improvement in SVV deviation and lateropulsion.

For example, using AR / MR technology, we synthesize an image of a moving object on the above-mentioned corrected image, and the task of tracking it (impulsive eye movement, smooth eye movement, convergence, etc.) and approaching objects It is possible to give tasks such as avoiding

(10) In the above embodiments, the rehabilitation of patients with lateropulsion symptoms has been described, but the present invention is suitable for patients with abnormal SVV deviation or stroke patients suspected of having abnormal SVV deviation. can be used for In addition, patients with encephalopathy, including stroke, who have higher brain dysfunction such as unilateral spatial neglect, are included. Also included are patients with diseases other than brain damage, such as acute vestibular neuritis, sudden deafness, and Meniere's disease. Furthermore, it is considered applicable to neurodegenerative diseases such as Parkinson's disease and multiple sclerosis, in which SVV is known to be biased.

1 head mount units 12, 13 display unit 14 camera (shooting unit)
222 image generator

Claims (9)

A support device for assisting rehabilitation,
a head-mounted unit that can be worn on the patient's head;
an imaging unit attached to the head-mounted unit and capable of capturing an image of an external scene corresponding to an external scene within the field of view of the patient;
an image generation unit that generates a corrected image by tilting the image captured by the imaging unit at a predetermined tilt angle according to the deviation of the subjective vertical position (SVV) of the patient;
a display unit attached to the head-mounted unit, the display unit displaying the correction image to the patient so as to correspond to the imaging of the image of the external scene by the imaging unit;
An assistive device comprising: An assistive device, wherein said rehabilitation is rehabilitation of a patient having lateropulsion. 3. A support device according to claim 1 or 2, configured to change the tilt angle during rehabilitation. 4. The support device according to any one of claims 1 to 3, wherein said correction image can be output to an external display device. 5. The support device according to any one of claims 1 to 4, further comprising an SVV measurement unit that measures said SVV. 6. The assisting device according to any one of claims 1 to 5, wherein said image generator is configured to synthesize an image for prompting said patient to correct with said correction image. 6. The support device according to any one of claims 1 to 5, wherein the image generator is configured to synthesize an image of a moving object that can be tracked by the patient with the corrected image. A support method for supporting rehabilitation,
a step of capturing an image of an external scene in the field of view of the patient and a corresponding external scene;
generating a corrected image in which the captured image is tilted at a predetermined tilt angle according to the patient's subjective vertical visual (SVV) deviation;
displaying the corrected image to the patient so as to correspond to capturing an image of the external scene;
Assistance method. 9. A method of assistance according to claim 8, wherein said rehabilitation is rehabilitation of a patient with lateropulsion.

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